Malignant hypercalcemia at a national referral center

A retrospective analysis

Abstract

Malignant hypercalcemia is the most frequent endocrinological emergency in cancer. The factors related to its occurrence have not been evaluated, nor are there any related studies in Colombia.

Objective: to determine the factors associated with the onset of malignant hypercalcemia (MH) in patients hospitalized at Instituto Nacional de Cancerología (2014-2019).

Design: a retrospective analytical case-control study. Population: 230 cases of adults with cancer and calcium corrected for albumin equal to or greater than 10.5 mg/dL and 223 controls of cancer patients with normal corrected calcium (8.5 to 10.4 mg/ dL) were included. Squamous cell carcinoma was used as the pairing variable.

Analysis: univariate and bivariate analyses between the variables and the occurrence of MH were conducted to determine association, and raw ORs were calculated. Depending on their statistical significance (p<0.05), they were included in the logistic regression for multivariate analysis and to rule out bias.

Results: the median calcium for cases: 12.98 mg/dL (11.64-14.42) vs. 9.4 mg/dL (9.02-9.74) (p < 0.0001). The two groups were similar in age and sex. There was more metastasis in the cases (60.0% vs. 39.91%) (p< 0.0001). Altogether, 54.34% of the cases developed neurological symptoms. The median hospital stay was 16 days (IQR 9-27) vs. 9 days (IQR 6-17) for the controls (p< 0.0001), and inpatient deaths occurred in 48.70% vs. 16.59% (p < 0.0001). The following showed an association with MH: normal albumin, OR 0.41 (95% CI 0.29-0.55); a Karnofsky Index greater than or equal to 70, OR 0.98 (95% CI 0.97-0.99); and metastasis, OR 1.87 (95% CI 1.23-2.84).